What Is a Benign Rolandic Epilepsy?
Benign rolandic epilepsy (BRE), also called benign epilepsy with centrotemporal spikes (BECTS) or benign epilepsy of childhood with centrotemporal spikes (BECCTS), accounts for the most common epilepsy syndrome in children. This condition usually outgrows the affected children by the time they reach puberty. It is given the term “rolandic” because the seizures originate in the rolandic (also called centrotemporal) area of the brain. This part of the brain controls the face, mouth, and throat.
A seizure is a disorder with sudden, uncontrolled electrical disturbance in the brain. This can lead to symptoms such as confusion, muscle jerking, and loss of consciousness.
What Causes Benign Rolandic Epilepsy?
The exact cause of benign rolandic epilepsy (BRE) is unknown. But it has been classified as a genetic disorder because approximately 25 percent of the patients having this condition have a family history of either epilepsy or febrile seizures (fits that happen when a child has a fever). Although there has not been any identification of a specific gene, chromosome 11 and chromosome 15 are thought to be involved in this condition.
When Does Benign Rolandic Epilepsy Occur?
Benign rolandic epilepsy (BRE) can occur between the ages of one to 14 years. However, the majority of the cases peak around seven to ten years of age. The predominance of benign rolandic epilepsy is seen in boys, as it occurs more frequently in boys than in girls. The incidence of this condition is 10 to 20 per 100,000 children aged less than 15 years, thereby making up for about 15 percent of all epilepsy cases in children. This leads to BRE being the most common epileptic syndrome in childhood. It does not affect adults.
What Are the Signs and Symptoms of Benign Rolandic Epilepsy?
Benign rolandic epilepsy (BRE) has the greatest incidence (70 percent) of occurrence at night or after waking up. Seizures originate from the rolandic area of the brain, which controls the face, mouth, and throat. They are infrequent, partial (focal), and with no loss of consciousness.
Symptoms are generally unilateral (affecting only one side of the face) and include:
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Facial twitching and stiffness.
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Numbness or tingling of the face and throat includes lips, tongue, gums, inner side of the cheek, and teeth.
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Speaking difficulties with gurgling (hollow bubbling) noises.
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Speech arrest (temporary inability to speak).
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Drooling of saliva.
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Hypersalivation (producing more saliva by the salivary gland than usual).
Seizures usually last for two to three minutes. Facial twitching of the face can spread and affect the arms and legs on the same side. Occasionally, seizures can become generalized by spreading and involving both sides. This can have other manifestations, such as:
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Generalized shaking.
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Stiffening of the body.
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Loss of bowel and bladder control.
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Loss of consciousness.
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Postictal state (recovery period after a seizure).
The occurrence of seizures mostly at night and being partial (affecting only one side) makes them go unnoticed until there is a full-blown generalized seizure. Status epilepticus (continuous seizures lasting for more than five minutes, without any period of recovery in between) and sudden unexplained death in epilepsy (SUDEP) are rare.
Other associated symptoms include:
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Behavioral and learning difficulties.
These symptoms are more common when the child has seizures and abnormalities in the electroencephalogram (EEG). However, when the child reaches age 15, they outgrow the seizures, the symptoms improve, EEG normalizes, and no developmental problems are seen.
How Is Benign Rolandic Epilepsy Diagnosed?
Similar to other epileptic syndromes, the diagnosis of BRE by a healthcare provider can be established based on the symptoms, family history, and a characteristic electroencephalogram (EEG) finding. The centrotemporal spikes seen in the EEG are indicative of BRE.
The healthcare provider may also order MRI (magnetic resonance imaging) scans to examine the brain of the child, but it is often unnecessary if the child has typical symptoms.
How Is Benign Rolandic Epilepsy Treated?
As suggested by the name, BRE is generally a benign condition. In addition, the child outgrows the seizures almost always by the time they reach adolescence. Therefore, BRE most often does not require any treatment. This is especially true because the seizures are mostly infrequent and partial and mainly occur at night if the child, parent, or family are agreeable.
The treatment may be considered when the seizures become severe and frequent, occur during the daytime, are generalized, and are associated with speaking and learning disabilities. The treatment decision should lie with the patient and their family whether or not to treat the condition in consultation with their healthcare provider.
The doctor may recommend a single antiepileptic drug (AED) if the treatment is considered necessary. It is sufficient, and rarely are multiple AEDs required. The dosage is suggested for nighttime.
Because of the partial or focal nature of the seizures, the drug Carbamazepine is usually the first-line agent. A few other drugs that have been used include:
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Oxcarbazepine.
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Gabapentin.
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Levetiracetam.
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Valproate.
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Phenytoin.
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Lacosamide.
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Zonisamide.
The treatment of BRE is usually of short duration and can be discontinued after the child becomes free of seizures for about one to two years. The dosage of antiepileptic drugs (AEDs) can be tapered and eventually stopped based on the electroencephalogram (EEG) findings (normal versus abnormal). However, there is a possibility of recurrence of seizures after the discontinuation of AEDs. The patient and their family should be aware of this possibility of recurrence and must be vigilant.
How to Help a Child During a Seizure?
If the child is having seizures, one must keep in mind the following points-
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Gently try to get them in a safe position.
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Keep all the sharp objects away.
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Do not try to restrict their movements.
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Do not put anything in their mouth.
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Lay them on their side because drooling occurs.
Conclusion:
Benign rolandic epilepsy, or BRE, is the most common epilepsy seen during childhood. However, it generally has an excellent outlook, and most children outgrow this condition by the time they reach puberty. The seizures occur primarily at night and after waking up. If the child has had a seizure, one must consult a healthcare provider for the proper diagnosis and appropriate management.
